Characteristics associated with swallowing changes after concurrent chemotherapy and radiotherapy in patients with head and neck cancer.
OBJECTIVE
To define factors that acutely influenced swallowing function prior to and during concurrent chemotherapy and radiotherapy.


METHODS
A summary score from 1 to 7 (the swallowing performance status scale [SPS]) of oral and pharyngeal impairment, aspiration, and diet, was assigned to each patient study by a single senior speech and swallow pathologist, with higher scores indicating worse swallowing. Generalized linear regression models were formulated to asses the effects of patient factors (performance status, smoking intensity, amount of alcohol ingestion, and age), tumor factors (primary site, T stage, and N stage), and treatment-related factors (radiation dose, use of intensity-modulated radiation therapy, response to induction chemotherapy, postchemoradiotherapy neck dissection, and preprotocol surgery) on the differences between SPS score before and after treatment.


METHODS
University hospital tertiary care referral center.


METHODS
The study included 95 patients treated under a multiple institution, phase 2 protocol who underwent a videofluorographic oropharyngeal motility (OPM) study to assess swallowing function prior to and within 1 to 2 months after the completion of concurrent chemotherapy and radiotherapy.


METHODS
Factors associated with swallowing changes after chemoradiotherapy.


RESULTS
The mean pretreatment and posttreatment OPM scores were 3.09 and 3.77, respectively. Patients with T3 or T4 tumors (odds ratio [OR], 0.38; 95% confidence interval [CI], 0.15-0.95; P = .04) and a performance status of 1 or 2 (OR, 0.37; 95% CI, 0.15-0.91; P = .03) were less likely to have worsening of swallowing after chemoradiotherapy. There was a trend for worse swallowing with increasing age (OR, 1.04; 95% CI, 0.99-1.09; P = .08). Only T stage (T3 or T4) was associated with improved swallowing after treatment (OR, 8.96; 95% CI, 1.9-41.5; P < .001).


CONCLUSIONS
In patients undergoing concurrent chemotherapy and radiotherapy, improved swallowing function over baseline is associated with advanced T stage.
Salama
Joseph K
JK
Department of Radiation and Cellular Oncology, 5758 S Maryland Ave, MC 9006, Chicago, IL 60637, USA. jsalama@radonc.uchicago.edu
Stenson
Kerstin M
KM
List
Marcy A
MA
Mell
Loren K
LK
Maccracken
Ellen
E
Cohen
Ezra E
EE
Blair
Elizabeth
E
Vokes
Everett E
EE
Haraf
Daniel J
DJ
D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D016001:Confidence Intervals; D003680:Deglutition Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection / Q000009:adverse effects / Q000379:methods; D009367:Neoplasm Staging; D016017:Odds Ratio; D011336:Probability; D011788:Quality of Life; D018714:Radiotherapy, Adjuvant; D011882:Radiotherapy, High-Energy / Q000009:adverse effects*; D012189:Retrospective Studies; D018570:Risk Assessment